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1921–2021: From insulin discovery to islet transplantation in type 1 diabetes
Annales d'Endocrinologie ( IF 2.9 ) Pub Date : 2021-04-08 , DOI: 10.1016/j.ando.2021.03.006
Mikael Chetboun 1 , Arnaud Jannin 2 , Julie Kerr-Conte 3 , François Pattou 1 , Marie-Christine Vantyghem 4
Affiliation  

One century after the discovery of insulin, the French Health regulations have just authorized the reimbursement for islet transplantation. Intraportal islet allotransplantation from a pancreatic donor is indicated in patients with type 1 diabetes (T1D) complicated with lability or hypoglycemia unawareness, or in case of a functioning kidney graft; islet auto-transplantation may be indicated after pancreatic surgery.Compared with insulin even administered in closed-loop pumps, the specificity of islet allotransplantation is the restoration of C-peptide secretion. Long-term insulin-independence is observed when the engrafted islet mass is sufficient, at the cost of immunosuppression. Fewer low-glucose events and less glucose variability, are observed even with minimal functional islet graft, after islet transplantation as at onset of T1D, when a residual C-peptide secretion is maintained, an objective currently approached with less aggressive immuno-modulating therapies than in the past. Therefore, restoration or preservation of endogen insulin secretion is an important goal, allowing to maintain a long-term glucose balance with more than 70% of time in range 3.9-10 mmol/L and less than 3% of time < 3.9mmol/L, thus reducing the occurrence of diabetic complications. In the clinical setting, - the preservation of C-peptide at early stage of T1D, - the use of technological ressources (multi-injections, sensors, insulin pump, closed-loop systems) at later stages, – and islet transplantation when hypoglycemia awareness becomes impaired are complementary for a personalized care all along the life of T1D patients.



中文翻译:

1921-2021:从发现胰岛素到 1 型糖尿病的胰岛移植

在发现胰岛素一个世纪后,法国卫生法规刚刚批准了胰岛移植的报销。来自胰腺供体的门静脉内胰岛同种异体移植适用于 1 型糖尿病 (T1D) 合并不稳定或低血糖无意识的患者,或功能正常的肾移植物;胰岛手术后可能需要胰岛自体移植。与胰岛素甚至在闭环泵中给药相比,胰岛异体移植的特异性是恢复C肽分泌。当移植的胰岛质量足够时,以免疫抑制为代价,观察到长期不依赖胰岛素​​。在胰岛移植后,在 T1D 发病时,即使使用最小的功能性胰岛移植,也观察到较少的低葡萄糖事件和较少的葡萄糖变异性,当残留的 C 肽分泌得以维持时,目前的目标是通过比过去更不激进的免疫调节疗法来实现。因此,恢复或保存内源性胰岛素分泌是一个重要目标,允许在超过 70% 的时间范围内维持长期葡萄糖平衡 3.9-10 mmol/L和小于3%的时间<  3.9mmol/L,从而减少了糖尿病并发症的发生。在临床环境中, - 在 T1D 早期保存 C 肽, - 在后期使用技术资源(多次注射、传感器、胰岛素泵、闭环系统), - 以及低血糖意识时的胰岛移植在 T1D 患者的整个生命周期中,变得受损是个性化护理的补充。

更新日期:2021-05-03
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